tbuckley/cabot-search huggingface dataset:
AB0747 Oral microbiome in rheumatic diseases.What involvement?
Authors: M. T. Ceccherini, S. Bellando-Randone, S. Guiducci, E. Romano, D. Carboni, K. El Aoufy, G. Lepri, L. Cometi, L. Tofani, M. Matucci-Cerinic, D. Melchiorre
Journal: Annals of the Rheumatic Diseases (2022)

Background The concept of core-microbiome in health is useful for investigating the possible role of the oral microbiome in autoimmune disease, such as Rheumatoid Arthritis, Spondyloarthritis, Sjogren Syndrome or Systemic Sclerosis (SSc), whose pathogenesis has not been fully understood. Environmental factors and certain genetic backgrounds have been proposed. Among the various environmental factors, the microbiota stands out, the entire composition of microorganisms, mainly bacteria but also fungi and viruses, which populate the human body. Objectives The aim of the study was to verify whether there were quantitative differences between the microorganisms present in the oral cavity, in particular between the lactobacillus spp., of patients with SSc compared to those present in the oral cavity of healthy subjects taken as controls. Methods Twenty-nine SSc female patients (mean age 62.) classified according to the ACR/EULAR2013 criteria and twenty-three female healthy subjects (HS, mean age 57.6) were enrolled and underwent tongue and gum swab sampling. Quantitative PCR was conducted in triplicates using Lactobacillus specific primers rpo B1, rpo B1o and rpo B2 for RNA-polymerase β subunit gene. Results Our data showed Lactobacillus spp. rpo B sequences significantly lower in the tongue of SSc patients than in HS (p=0.0211 ).The statistical analysis in HS highlighted a significant lower amount of rpo B on the gums than on the tongue. Conclusion Our preliminary data show that the number of Lactobacillus on the tongue in SSc patients is about half that of HS. These data make it more likely that Lactobacillus in SSc patients may play a protective role. Further investigations will also be needed in other autoimmune diseases. References [1]Zaura E, Keijser BJ, Huse SM, Crielaard W Defining the healthy “core microbiome” of oral microbial communities. BMC Microbiol. 2009 Dec 15;9:259. doi: 10.1186/1471-2180-9-259. [2]Nikitakis NG, Papaioannou W, Sakkas LI, Kousvelari E. The autoimmunity-oral microbiome connection. Oral Diseases (2017) 23, 828-839. Disclosure of Interests None declared
Safety and efficacy of rituximab in systemic sclerosis (DESIRES): open-label extension of a double-blind, investigators-initiated, randomised, placebo-controlled trial
Authors: Satoshi Ebata, Ayumi Yoshizaki, Koji Oba, Kosuke Kashiwabara, Keiko Ueda, Yukari Uemura, Takeyuki Watadani, Takemichi Fukasawa, Shunsuke Miura, Asako Yoshizaki-Ogawa, Naoko Okiyama, Masanari Kodera, Minoru Hasegawa, Shinichi Sato
Journal: The Lancet Rheumatology (2022)
Hemorrhage Risk Among Patients With Breast Cancer Receiving Concurrent Direct Oral Anticoagulants With Tamoxifen vs Aromatase Inhibitors
Authors: Tzu-Fei Wang, Anna E. Clarke, Arif A. Awan, Peter Tanuseputro, Marc Carrier, Manish M. Sood
Journal: JAMA Network Open (2022)

<h3>Importance</h3> Tamoxifen is commonly used as adjuvant therapy in breast cancer and is proposed to interfere with cytochrome P450 enzyme and P-glycoprotein pathways. Concurrent use with direct oral anticoagulants (DOACs) poses the threat of a potentially dangerous drug-drug interaction by leading to an increase in hemorrhage risk. <h3>Objective</h3> To assess the risk of hemorrhage in patients with breast cancer coprescribed a DOAC and tamoxifen compared with a DOAC and an aromatase inhibitor (AI). <h3>Design, Setting, and Participants</h3> This population-based, retrospective cohort study was conducted among adults aged 66 years or older who were prescribed tamoxifen (compared with an AI) concurrently with a DOAC in Ontario, Canada, between June 23, 2009, and November 30, 2020, and followed up until December 31, 2020. <h3>Interventions</h3> Concurrent prescription of a DOAC and tamoxifen compared with a DOAC and an AI. <h3>Main Outcomes and Measures</h3> The primary outcome was major hemorrhage requiring an emergency department visit or hospitalization after prescription. Overlap weighted Cox proportional hazards models, accounting for multiple covariates, were used to assess the association between hemorrhage and tamoxifen or AI use with a DOAC. <h3>Results</h3> Among a total of 4753 patients (4679 [98.4%] women; mean [SD] age, 77.4 [7.4] years), 1179 (24.8%) were prescribed tamoxifen, and 3574 (75.2%) were prescribed an AI. Rivaroxaban (2530 [53.2%]) and apixaban (1665 [35.0%]) were the most frequently used DOACs. Patients taking AIs were younger than patients taking tamoxifen (mean [SD] age, 77.1 [7.3] vs 78.3 [7.6] years), with higher Charlson Comorbidity Index (mean [SD], 1.8 [2.4] vs 1.5 [2.2]) and more advanced cancer stage (stages III and IV, 569 [15.9%] vs 127 [10.8%]). During a median follow-up of 166 days (IQR, 111-527 days), tamoxifen was not associated with a higher risk of major hemorrhage (29 of 1179 [2.5%]) compared with an AI (119 of 3574 [3.3%]) when combined with a DOAC (absolute risk difference, −0.8%; weighted hazard ratio, 0.68 [95% CI, 0.44-1.06]). These results were similar in additional analyses using a more liberal definition of hemorrhage, accounting for kidney function, limiting follow-up to 90 days, stratifying by incident and prevalent DOAC users, and accounting for cancer duration and the competing risk of death. <h3>Conclusions and Relevance</h3> In this cohort study, findings suggest that among DOAC users, the concurrent use of tamoxifen was not associated with a higher risk of hemorrhage compared with the concurrent use of an AI. These findings should directly inform prescribers regarding the apparent safety of concurrent DOAC and tamoxifen use.
POS1167 EFFICACY AND SAFETY OF FEBUXOSTAT IN PATIENTS WITH STAGE 4-5 CHRONIC KIDNEY DISEASE NOT YET ON DIALYSIS: A META-ANALYSIS OF OBSERVATIONAL STUDIES
Authors: C. N. Son, H. J. Jeong, W. Y. Park, S. H. Kim
Journal: Annals of the Rheumatic Diseases (2022)

Background The efficacy and safety of febuxostat in patients with stage 4-5 chronic kidney disease (CKD) are still unclear, even though it’s commonly used in clinical practice [1]. However, clinical trials are lacking to determine them due to ethical problems about enrollment of advanced CKD patients. Objectives We aimed to evaluate the efficacy and safety of febuxostat in patients with stage 4-5 CKD not yet on dialysis through a meta-analysis of observational studies. Methods We performed a systematic search in PubMed, Ovid MEDLINE, Embase, and the Cochrane Library to find articles reporting on advanced CKD patients from observational cohorts who start or take febuxostat at baseline in September 2021. Articles had to describe change from baseline in serum urate levels and renal function as assessed by estimated glomerular filtration rate (eGFR). The articles were screened by two independent reviewers (YP, HJ). Meta-analysis using a random-effects model was performed. R software was used for statistical analyses. Results Among 148 retrieved studies, 5 relevant observational studies were included in the meta-analysis. The febuxostat dose was administered at 10-120 mg per day, and the treatment period was 3 to 12 months. Five studies were included with a total of 327 patients to analyze urate-lowering efficacy. The urate-lowering effect after use of febuxostat medication showed statistical significance (weighted mean difference, -1.85; 95% CI, -2.04 to -1.67; I 2 ; 0%, Figure 1A). Three studies with 145 patients were available for assessment of eGFR. Renal function as assessed by eGFR did not decrease even after use of febuxostat (weighted mean difference, 0.11; 95% CI, -0.25 to 0.47; I 2 ; 45%, Figure 1B). Figure 1. Meta-analyses of serum urate levels and estimated glomerular filtration rate at baseline and follow-up. Conclusion Our meta-analysis showed that febuxostat had good urate-lowering efficacy and renal safety in hyperuricemia patients with stage 4-5 CKD, who are not yet on dialysis. More studies with larger sample sizes and higher quality are required to clarify the efficacy and safety of febuxostat in advanced CKD. References [1]Kim SH, Lee SY, Kim JM, Son CN. Korean J Intern Med 2020;35:998–1003. Disclosure of Interests None declared
POS1544-HPR RHEUMATOID ARTHRITIS CONTROL USING SYNCHRONOUS TELEMEDICINE MODALITY IN THE PANDEMIC PERIOD
Authors: L. J. Cajas Santana, D. Cajas
Journal: Annals of the Rheumatic Diseases (2022)

Background Telemedicine is a useful tool in the control of patients with rheumatological conditions, even more so in the pandemic period. The evolution of patients with rheumatoid arthritis (RA) treated exclusively under this modality has been scarcely described. Objectives Evolution of clinical activity in RA patients controlled exclusively by the synchronous telemedicine (ST) modality in the COVID-19 pandemic period. Methods An observational study was carried out.Two group of patients were analyzed separately, first group who had been treated using ST before the declaration of a health emergency in Colombia in march 2020 and second who were admitted to ST after this date. ST consists of a real-time video call with a trained general physician help on the referral site to performed physical examination. Assessments of disease activity was measured by DAS28 using C-reactive protein. Results Data was obtained from 150 and 65 patients in the first and second group. For the first group, more than a half of the patients had 2 controls with DAS28 assessment after march 2020, only 33% obtained 3 assessments, and very few with 4 or more. We found that the number of patients with high activity decreased significantly from 10% to 3%, remission increased from 44% to 50% and low activity from 14% to 19%, without major changes in the moderate activity group that remained close to a third. Same tendencies happened in group 2, with a difference in reduction of the moderate activity group from 44% to 38% (Figure 1). Conclusion When in person attention with rheumatologist is not possible, telemedicine is a useful and efficient way to control patients with RA, mainly finding a reduction in high activity and an increase patients in remission. References [1]Jhon A. McDougall .Telerheumatology: A Systematc Review. Arthrits Care and Research Vol 69, No October 2017, pp 1546-1557 [2]Luis Cajas. Description of a tele-rheumatology service in a Colombian institution. Rev Colomb Reumatol 2021; 28(3):161-170 Disclosure of Interests LUIS JAVIER CAJAS SANTANA Speakers bureau: Pfzer, Bristol, Janssen, Diego Cajas: None declared
AB1075 KNEE ARTHRITIS BY PARACOCCIDIOIDES BRASILIENSIS IN A LONG-STANDING RHEUMATOID ARTHRITIS PATIENT
Authors: M. Barguil Macedo, C. Gama, I. P. D. B. Antonelli, F. H. C. De Souza, A. C. Medeiros Ribeiro
Journal: Annals of the Rheumatic Diseases (2022)

Background Arthritis by Paracoccidioides brasiliensis is a remarkably unusual etiology of infectious joint disease. While osseous lesions can be present in systemic disease, intra-articular-restricted disease without typical lung or lymph node involvement is mostly anecdotal 1,2 . Objectives We hereby describe a case of this fungal arthritis in a patient with rheumatoid arthritis (RA) without significant immunosuppression. Methods Patient records review. Written informed consent was obtained. Results A 65-year-old female Brazilian patient with a 35-year history of seropositive RA complained of a painful knee edema for the last three weeks. Skin surrounding the joint was erythematous, warm, and tender to the touch, which initially raised the suspicion of cellulitis. She had already received a 10-day course of amoxicillin-clavulanate, with no improvement. C-reactive protein was 17.8 mg/L, rest of blood chemistry panel was within reference range. Point-of-care ultrasound revealed joint effusion, and a diagnostic arthrocentesis was performed. Synovial fluid was slightly turbid, with 10,100 cells per mm 3 , of which 80% were lymphocytes. Cultures for bacteria and mycobacteria yielded negative results, but culture for fungi detected growth of P. brasiliensis . The patient had been solely on prednisone 5 mg once daily for the last year, given that, due to covid-19 pandemics, she lost regular follow-up and abandoned treatment with immunosuppressants. Aside from mild RA-related interstitial lung disease, she had no other comorbidity. She denied local trauma to the knee, which made hematogenous dissemination of the fungi the most probable source. Comprehensive work-up to search for organic involvement of paracoccidioidomycosis, including chest computed tomography and transthoracic echocardiogram, did not evidence any visceral compromise. Voriconazole 200mg t.i.d. was started, with good response. Three months after the beginning of the azole, tofacitinib was started for moderate RA disease activity, which also responded satisfactorily. Repeat arthrocentesis and synovial biopsy were performed eight months after the start of antifungal treatment, the former being normal (770 cells per mm 3 , negative cultures), and the later only demonstrating non-specific chronic synovitis with fibrosis. Conclusion We reported an exceedingly rare presentation of P. brasiliensis infection with exclusive joint involvement. References [1]Silvestre MTA, Ferreira MS, Borges AS, et al. Monoartrite de joelho como manifestação isolada de paracoccidiodomicose. Rev. Soc. Bras. Med. Trop. 1997 Oct, 30(5): 393-5. doi: 10.1590/S0037-86821997000500008 [2]Bonilla-Abadía F, Vélez JD, Zárate-Correa LC, et al. Overinfection by Paracoccidioides brasiliensis in Gouty Crystal Arthritis. Case Rep Med. 2012;2012:128103. doi:10.1155/2012/128103 Disclosure of Interests None declared
AB0615 Clinical impact of ceruloplasmin levels at ANCA-associated vasculitis diagnosis
Authors: L. Camboulive, F. Grandhomme, N. M. Silva, H. de Boysson, A. Dumont, A. Nguyen, D. Mariotte, K. Khoy, T. Lobbedez, A. Aouba, S. Deshayes
Journal: Annals of the Rheumatic Diseases (2022)

Background Myeloperoxidase (MPO) plays a major role in loss of immunological tolerance leading to tissue destruction in ANCA-associated vasculitis (AAV). Ceruloplasmin is a protein with antiproteinase and antioxidant properties that inhibits MPO activity. Whether serum level of ceruloplasmin at AAV diagnosis has an impact is unknown. Objectives The objective of this study was to evaluate the prognostic impact of serum level of ceruloplasmin at diagnosis in patients with granulomatosis with polyangiitis or microscopic polyangiitis. Methods We conducted a retrospective unicentric study at Caen University Hospital, involving consecutive adult patients with granulomatosis with polyangiitis or microscopic polyangiitis between 2010 and 2021 who had available serum at diagnosis. Data was collected using the health records. Ceruloplasmin was measured by standardized nephelometry (normal values: 0.15 – 0.50 g/L). Patients in each subgroup (whole cohort, microscopic polyangiitis and anti-MPO patients) were divided into two groups based on the median serum level of ceruloplasmin. We estimated survival using the Kaplan-Meier survival curve, and between-group differences were evaluated by the log-rank test. The study was approved by the local ethics committee of Caen University Hospital (n° 1947). Results Ninety-two patients were included, 46 (50%) granulomatosis with polyangiitis (41 anti-proteinase 3 and 5 anti-MPO) and 46 (50%) microscopic polyangiitis (45 anti-MPO and 1 anti-proteinase 3). The median level of ceruloplasmin was 0.44 g/L. No significant differences in the clinical presentation were observed between patients in the two groups (p&gt;0.05). We observed 9 (19.6%) deaths in the low ceruloplasmin group and 5 (10.9%) in the high ceruloplasmin group (p=0.39). Vasculitis relapse occurred in 10/46 patients (22%) and 11/46 patients (24%) (p=1), renal failure leading to dialysis and/or renal transplant in 6/46 patients (13%) and 8/46 patients (17%) (p=0.77), respectively. No significant difference in survival was found (p=0.07). The same analyses were performed between the low and the high ceruloplasmin group with the microscopic polyangiitis subgroup (n=46), and no significant differences were found (p&gt;0.05). However, within the anti-MPO subgroup (n=50), the survival was worse in the low ceruloplasmin group (p=0.03). Conclusion In anti-MPO AAV patients, serum level of ceruloplasmin at diagnosis seems to be associated with a significant impact on survival. References [1]Baskin E, et al. Ceruloplasmin levels in antineutrophil cytoplasmic antibody-positive patients. Pediatr Nephrol. 2002;17(11):917–9. [2]Ara J, et al. Ceruloplasmin in small vessel vasculitis. Nephrol Dial Transplant . févr 1999;14(2):515-7. isclosure of Interests: None declared
AB0459 NATIONAL TEMPORAL TRENDS IN ALL-CAUSE MORTALITY IN PATIENTS WITH SYSTEMIC SCLEROSIS IN MEXICO BETWEEN 1998-2017
Authors: P. Munguía-Realpozo, M. García Carrasco, I. Etchegaray-Morales, J. Ayón-Aguilar, O. Navarro-Milán, C. Mendoza Pinto
Journal: Annals of the Rheumatic Diseases (2022)

Background Systemic sclerosis (SSc) is a rare chronic connective tissue disease characterized by vascular injury, immune dysregulation, and extensive fibrosis of several organs. Due to its rarity, epidemiological data for SSc are sparse. Objectives To investigate national temporal trends over time in all-cause mortality rates in patients with systemic sclerosis (SSc) in Mexico between 1998 and 2017. Methods All-cause deaths between 1998 to 2017 were extracted from the General Board of Health Information (DGIS) Open Access datasets. We identified all persons aged ≥18 years with a diagnosis of SSc (ICD-10 code M34). We calculated the age-standardized mortality rate (ASMR) for SSc and non-SSc (information provided by the National Institute of Statistics, Geography and Informatics). A Joinpoint regression model was used to determine mortality trends by sex and geographic regions. Annual percentage change (APC) and average APC (AAPC) were calculated using Joinpoint analysis. Results From 1998 to 2017, the overall ASMR of SSc increased (AAPC= 2.5%), whereas the ASMR for non-SSc remained stable. By subpopulations, females and males with SSc had a significant uptrend in the ASMR (APC= 4.6% and 4.4%, respectively), between 1998 and 2008 for the former and between 1998 and 2010 for the later. Females had a non-significant ASMR uptrend and males a non-significant ASMR decline. Some variations among geographic regions were found. Women had a higher SSc AMSR to non-SSc ASMR ratio than males. The relative cumulative change between 1998 and 2017 differed between females (78.1%) and males (50.8%), and residents of the Southern region had the largest cumulative change (147.8%). Conclusion SSc mortality rate increased in Mexico between 1998 to 2017, with SSc mortality higher than non-SSc mortality with variations by sex and geographic regions. References [1]Rubio-Rivas M, Royo C, Simeón CP, et al (2014) Mortality and survival in systemic sclerosis: systematic review and meta-analysis. Seminars in arthritis and rheumatism 44:208–219. doi: 10.1016/j.semarthrit.2014.05.010 [2]Butt SA, Jeppesen JL, Fuchs C, et al (2018) Trends in incidence, mortality, and causes of death associated with systemic sclerosis in Denmark between 1995 and 2015: a nationwide cohort study. BMC rheumatology 2:36. doi: 10.1186/s41927-018-0043-6 Disclosure of Interests None declared
AB1288 FIRST USE OF ETORICOXIB FOR LOBULAR PANNICULITIS
Authors: B. Belov, O. Egorova
Journal: Annals of the Rheumatic Diseases (2022)

Background Non-steroidal anti-inflammatory drugs (NSAIDs) are the primary means of controlling chronic pain in many rheumatic diseases and, in particular, in lobular panniculitis (LPn). Objectives to evaluate a possibility of effective and safe control of patients with LPn during long-term use of NSAIDs in clinical practice. Methods We studied 21 patients (15 women and 6 men, average age 41.2±9.3 years) with LPn who were treated with etoricoxib in a dose of 60 mg/day. Patients’ condition was assessed at the time of prescription, after 2 and 4 weeks of therapy, and 4 weeks after discontinuation of treatment (8 weeks from baseline). Localization, prevalence, color and number of affected skin areas and subcutaneous fat were determined during clinical examination. Pain intensity in motion was evaluated by 10-cm Visual Analog Scale (VAS), as well as general health score (GHS) on a 10-cm VAS, pain intensity on the Likert Verbal Rating Scale (VRS) (0-4), number of patients with pain reduction ≥50% from baseline, and patients’ assessment of therapy outcome on the Likert VRS (1-5). Adverse reactions (ARs) were evaluated at each visit. General clinical examination included standard diagnostic methods. Results In 90% of cases, the affected areas of skin and subcutaneous fat were located on the tibia, mainly on the anterior and medial surface, in 33% – on the hips, in 24% – on the upper extremities, and in 5% – on the torso. Symmetrical rashes occurred in 62% of patients. In 48% of patients the nodes merged into a conglomerate. The fact that more than 50% of the lower leg surface (67%) was affected was directly associated with the number of nodules (p &lt; 0.001; r = 0.60) and C-reactive protein level (p = 0.006; r = 0.38). There was a direct correlation between the number of nodules and the duration of LPn (p = 0.04; r = 0.20) and their tendency to merging (p &lt; 0.001; r = 0.39). Signs of joint involvement were detected in 14 patients (67%), with predominant involvement of the ankle (67%) and knee (38%) joints. In 29% of the patients, the affected joints were asymmetrical. All patients took Etorax for 4 weeks. Mean pain severity (according to VAS) at baseline, after 2, 4 and 8 weeks was 6.5±1.2; 4.8±1.4; 2.6±1.4; 2.2±1.1 cm (significant difference from baseline in all points, p&lt;0.05). Similarly, there was a statistically significant difference in VAS values. The number of patients with moderate/severe pain (Likert scale) decreased from 77.8% to 24.9%, 2.9%, and 2.3%. The number of patients with pain reduction ≥50% from baseline were 12.0%, 65.1%, 81.0%, and 78.5%. A good or excellent rating of the treatment results after 2 weeks was demonstrated by 57.1% and after 4 weeks by 76.1% of patients. ARs were registered in approximately 14.2% of patients, mostly mild dyspepsia (in 5%) and arterial hypertension (in 10%). No severe ARs were reported Conclusion Etoricoxib is effective and relatively safe for long-term control of chronic pain in LPn. Disclosure of Interests None declared